After Obamacare Cracks Up, Then What?

[The disaster that is Obamacare continues to grow, even as the mainstream media remains in denial about the program’s inevitable crack-up. In the guest essay below, Neal Muhlberg, a licensed health insurance agent with 25 years of experience, examines some of the ACA’s failures. He fears, however, that the best opportunity to replace the program with one that works came and went with the unsuccessful presidential bid of Ron Paul. Even so, there are glimmers of hope in evolving health care practices such as “concierge care,” which allows patients to pay with cash rather than insurance in order to receive prompter and more-attentive care. RA]

A new McKinsey & Co. report finds that Obamacare’s goal of providing coverage for the previously uninsured has failed. The report concludes that 74% of Obamacare enrollees at the end of the first open-enrollment period already had health insurance. Just 26% reported being previously uninsured. According to the Associated Press, at least 4.7 million policy holders lost their health insurance policies when their plans were declared “substandard.” Many of those individuals simply went through the Obamacare exchanges to buy policies to replace the ones outlawed by the Affordable Care Act.

The same phenomenon occurred almost 50 years ago, when Lyndon Johnson implemented the Great Society programs of Medicare and Medicaid, ordering all insurance companies to cancel major medical policies for those 65 years or older, and charging a tax that everyone was forced to pay for programs whose resemblance to a Ponzi scheme has become increasingly obvious over time.  Under the ACA, this is occurring again for those under age 65. Is there any hope that the voters will rise up and throw the rascals out, repealing this disastrously misguided law? I hope so, but I doubt it.

No Real Choice

Let me explain. Polls indicate extreme dissatisfaction with all aspects of the ACA. It seems like the American voters are constantly being suckered into choosing between left-wing socialized medicine (Obamacare) and right-wing socialized medicine (Romneycare in Massachusetts, the model for the ACA).  In the process, the Republican Party (and, of course the Democrats) rejected and slandered the only free-market candidate, as well as the only physician who was a serious Presidential contender, Ron Paul, a 12-term member of the House of Representatives.  Between political runs, Dr. Paul delivered over 4,000 babies in his lower-middle-class Texas district, much of his services given for free to those who couldn’t afford it. He and most doctors of that era were true to their Hippocratic oath.

In reaction to the ACA’s strictures and to increasingly stingy reimbursement by Medicare and Medicaid for basic services, many doctors are taking early retirement or limiting the number of Medicaid and Medicare patients they see. It is predictable that much longer waits to see doctors or get MRI scans are on the horizon as the ACA slowly roots itself. Doctor shortages can only get worse, since we are seeing far fewer top students choose medical school because of the huge debts they and their parents will incur and the uncertainties they will face when they emerge into a professional world that even now is being upended.

Doctors Shun Insurance

There is hope, however. Many doctors are no longer accepting insurance, instead forming concierge medical practices that give patients some attractive payment options. For one, you can often pay as little as $25 in cash for an office visit, or get unlimited visits for a set monthly payment of between $50 and $150. More and more care providers are also starting to offer free EKGs and biopsies, and cut-rate prices on prescription drugs. Many patients have catastrophic insurance but feel the fee is well worth it for personalized service, including house calls, the doctor’s cell-phone number, and quick responses to e-mails.

Before Medicaid there were various “mutual benefit societies” formed voluntarily by health care providers to ease the burden on those who could not afford emergency care. Such organizations may be formally organized with charters and established customs, or may arise ad hoc to meet unique needs of a particular time and place. There were, and still are, many religion-affiliated hospitals whose charters demand that they treat a significant percentage of indigent, or poor /lower middle-class people who don’t have insurance. [Note: A story out this morning in the New York Times suggests this charitable practice may be in jeopardy because of Obamacare. Click here for the full article.]

Medical Vacations

In addition, medical vacations are becoming increasingly popular to destinations that offer surgical and diagnostic procedures at a cost far lower than in the U.S.  Let’s say you need stomach surgery that would cost $30,000 in a typical U.S. hospital. That same procedure, including airfare and a hotel room for a ten-day recovery period, will cost you less than $5,000 in India. “Medical tourism” is available in Mexico, Costa Rica, Panama and many other countries.

For those who want relatively cheap coverage for true major-medical needs, short-term policies are still available at very affordable premiums. These plans are underwritten, however, and so not everyone can qualify. Critical-illness insurance is also a becoming more widespread. These plans pay directly to the insured a lump sum of $5,000 to $500,000 upon diagnose of a critical illness.  Also, small-business group plans are still available, but a business owner must have at least one employee ( and up to 50). Like ACA coverage, these plans are “guaranteed issue” for pre-existing conditions, and there aren’t any open enrollment periods as with the ACA. These plans, however, are in danger of being outlawed unless we actually do throw the rascals out.

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